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Home , Urinary system

Jordan University of Science and Technology Faculty of

Course Title: Urinary and Course Code: M352. Credit Hours: 8 credit hours. Calendar Description: 8 weeks/ Sem 2/ year 3. Teaching Approaches: Integrated System Course. Contact: [email protected]

A. Course description This course is a multidisciplinary integrated course deals with the gross morphology, vasculature, lymphatic drainage and innervation of different organs forming urinary and reproductive system. Various functions, normal development and congenital anomalies of this system will be covered. In addition, normal and pathological microscopic appearance of different components of the system will be discussed. Biochemical and genetic aspects, microorganisms that infect the system as well as drugs that affect this system will be conferred. Teaching methods including lectures, practicals, seminars and small group discussions of clinical oriented problems to enhance self directed learning, will be followed.

B. Genral Objectives Upon succesful completion of this course students should be able to: 1. Describe the gross morphology of different organs forming the Urinary and Reproductive System. 2. Understand the normal development of the Urinary and Reproductive System and its congenital anomalies. 3. Discuss the vasculature, lymphatic drainage and innervation of different parts of the Urinary and Reproductive System. 4. Understand various functions of the Urinary and Reproductive System. 5. Describe the microscopic appearance of different components of the Urinary and Reproductive System. 6. Discuss the microorganisms that infect the Urinary and Reproductive System. 7. Understand the pathogenesis of various diseases of the Urinary and Reproductive System. 8. List and describe the of various drugs acting on the Urinary and Reproductive System. 9. Understand the bases of the inherited diseases. II. Methods of Instruction: - Lectures. - Practical sessions. - Clinically oriented discussions. III. Evaluation and Distribution of Marks: - Written exam at the end of the system * = 40% - Practical exam at the end of the system * = 16%. - Discussion evaluation*= 4% - Final end-course exam at the end of the semester (Written)* = 40%. * Indicates integrated exam format 1 IV. Recommended Text Books and Atlases:  : - Principles of Anatomy. By G.J. Tortora, latest edition. - Clinical Anatomy for Medical Students: By R.S. Snell, latest edition. - Basic Histology, By L. Carlos Junqueira, latest edition. - Before we are born. By K.L. Morre and T.V.N. Persaud, latest edition. - Grant Atlas of Anatomy, latest edition.

 Physiology: - Textbook of Medical Physiology. By Guyton and Hall, latest edition.

 Biochemistry: - Harper’s Biochemistry. By Robert K. Murray and Co., latest edition. - Supplementary Departmental Handouts.

 Pharmacology: - Lippincott’s IIIustrated Reviews: Pharmacology, latest edition. - Supplementary Departmental Handouts.

 Pathology: - Basic Pathology. By Kumar, Cotran and Robbins, latest edition. - Supplementary Departmental Handouts.

 Microbiology: - Medical Microbiology. An Introduction to Infectious Diseases. By Sheries, latest edition.

 Public Health (Community Medicine): - Supplementary Departmental Handouts.

2 C. Learning (specific) objectives of the Urinary & Reproductive system: After studying the material covered in lectures, practical sessions, clinical seminars and case presentations of this course, and after using his/her private self learning time in a productive way, the student is expected to achieve the following specific objectives: Lectures: # Lecture Title Lecture Objectives 1 Introductory case presentation for the 1. Understand the general outline of the urinary system. urinary part of the system 2. Be familiar with the modalities of teaching throughout the course. (Multidisciplinary) 3. Acknowledge the important relation between normal and abnormal structure and function. 4. Appreciate the importance of basic sciences in clinical application.

2 General topographic anatomy of the 1. Overview of the urinary system. urinary system. 2. : understand its gross appearance, location in the body, (Anatomy) relation to important organs in the . 3. Describe the shape of the kidney, dimentions, surfaces, poles and the perirenal fat pad. 4. Understand the gross appearance of the internal structures: cortex, medulla, calicies and . 5. Understand the supply and how it is distributed, the venous drainage and how it is collected. 6. Discuss the lymphatic drainage and nervous control of the kidney.

3 Gross anatomy of the urinary system, 1. Understand the anatomical structure of the and its location in blood vessels, lymphatic drainage and the body. innervation. 2. Describe how pain is referred from both kidnies and . (Anatomy) 3. Understand the blood supply, venous drainage and lymphatics of the urinary system. 4. Discuss the innervation of different parts of the urinary system, with special attention to the nervous control of .

4 Embryology of the urinary system. 1. Understand the development of the kidney and related organs of (Anatomy) the urinary system. 2. Define the pronephrons, mesonephrons and metanephrons. 3. Understand the major and common congenital abnormalities in the urinary system.

5 Histology of the kidney. 1. Describe the normal microscopic appearance of the different parts (Anatomy) of the kidney including cortex, medulla, juxtaglomerular apparatus and the distribution of the vasculature within the kidney. 2. List the different parts of the with the details of each part.

6 Congenital and cystic diseases of the 1. Define the main congenital diseases of the kidney. kidney. 2. Understand different types, pathogenesis, morphology, and (Pathology) presentation of cystic diseases of the kidney.

7 Glomerular filtration (GF). 1. Review the functions of the nephron. (Physiology) 2. Understand the process of renal blood flow and glomerular filtration. 3. Understand the glomerular membrane, and the dynamics of glomerular filtration. 4. List the factors that affect glomerular filtration rate (GFR). 8 Reabsorption and secretion. 1. Understand the transport and the pathways of reabsorption. (Physiology) 2. Discuss the reabsorption of and . 3. Discuss the reabsorption of glucose, , creatinine and .

9 Special aspects of renal metabolism. 1. Discuss urea and creatinine metabolism. Role of kidney in acid base balance. 2. Understand the role of kidney in the regulation of hydrogen ions (Biochemistry) and bicarbonate buffer system. 3. Discuss amino acids absorption by the kidney and their disorders.

3 10 Regulation of the GF and renal-blood 1. Understand the autoregulation and tubuloglomerular feedback. flow (RBF). 2. Understand the juxtoglomerular apparatus and its role in renin- (Physiology) angiotensin system. 3. Understand the glomerulotubular balance.

11 Glomerulonephritis. 1. Discuss the pathogenesis of glomerulonephritis. (Pathology) 2. Recognize the basic reactions of glomerulous to injury. 3. List the different renal syndromes associated with renal Pathology.

12 Nephritic syndrome. 1. Discuss the manifestations and mechanism of nephritic syndrome. (Pathology) 2. List the types of glomerulonephritis associated with nephritic syndrome. 3. Discuss the etiology, pathogenesis, morphology and clinical features of the common types of glomerulonephritis leading to nephritic syndrome.

13 Nephrotic syndrome. 1. List the components of nephrotic syndrome. (Pathology) 2. Discuss the pathogenesis of nephrotic syndrome. 3. List the main causes of nephrotic syndrome. 4. Discuss the etiology, morphology, pathogenesis and clinical features of the common types of glomerulonephritis leading to nephrotic syndrome. 14 Glomerular pathology in systemic 1. Discuss the glomerular lesions associated with disease. - mellitus. (Pathology) - Systemic lupus erythematosis. - Henoch-shonlein purpura. - Multiple myeloma. - Gout. - Endocarditis. 15 Parameter of renal active transport. 1. Discuss the renal tubular transport maximum (Tm). (Physiology) 2. Define the filtered load and excretion. 3. Understand the glucose and para-aminohippuric acid (PAH) titration curve.

16 Renal clearance. 1. Understand the mechanisms of renal clearance and its applications. (Physiology) 2. Describe the inulin, creatinine and PAH clearance.

17 Renal concentration and dilution of 1. Understand the mechanisms of dilution and concentration . - Counter current multipliers. (Physiology) - Counter current exchangers. 2. Discuss the role of urea.

18 Diuretic agents-I. 1. List major types of diuretics and relate them to their sites of action. (Pharmacology) 2. List the major applications, toxicities, and the efficacy of thiazides, loop diuretics and -sparing diuretics. 3. Describe two drugs that reduce potassium loss during diuresis. 19 Diuretic agents-II. 1. Describe a therapy that will reduce excretion in patients (Pharmacology) who have recurrent urinary stones. 2. Discuss the principle of force diuresis. 3. Describe the drugs for reducing urine volume in nephrogenic diabetes insipidus.

20 Gross anatomy and histology of ureter 1. Describe the structure of the urinary bladder and its relations to the urinary bladder and . peritoneum. (Anatomy) 2. Understand the urethra and the difference between males and females. 3. Describe the structure and relations of the male urethra in different regions. 4. Describe the microscopical appearance of the ureter, urinary bladder and urethra. 5. Compare the histological appearance of the distended and contracted bladder.

4 21 (UTI). 1. Understand the role of E.coli and other gram negative bacteria as well as (Microbiology) gram positive organisms in UTI, their laboratory diagnosis and susceptability to antibiotics.

22 Diseases of blood vessels; renal 1. Define causes, pathogenesis, pathology and presentation of renal failure. diseases of blood vessels. (Pathology) 2. Contrast acute and chronic renal failure with the emphasis on pathogenesis, causes, morphology and clinical course

23 Drugs and the Kidney. 1. Understand the usefullness of altering urine pH by drugs. (Pharmacology) 2. Discuss the mechanisms by which drugs and chemicals damage the kidney. 3. Understand how to select and prescribe drugs for patients with renal impairment.

24 . 1. Describe Schistosoma Hematobium, its pathogenesis, immune (Microbiology) response, epidemiology, life cycle and clinical manifestations. 2. Describe the laboratory diagnosis,treatment, prevention and control measures.

25 Tubulointerstitial nephritis; urinary 1. Define the features and general morphology of tubulointerstitial tract infection. nephritis. (Pathology) 2. Define the pathogenesis, morphology and clinical features of drug induced tubulointerstitial nephritis. 3. Define the morphology and clinical features of acute and chronic . 4. Define the morphology and clinical features of and the common sites of ureteric obstruction. 5. Discuss the pathogenesis, clinical features and types of urinary stones. 6. Discuss the predisposing factors, causes and pathology of cystitis.

26 Renal tumors; pathology of ureter 1. Discuss the main features of and (benign and urinary bladder. renal neoplasms) (Pathology) 2. Discuss the risk factors, morphology and clinical features of (RCC). 3. List the main features of urothelial carcinoma of the 4. Discuss the risk factors, morphology and clinical features of nephroblastoma. 5. Describe the pathology of including; epidemiology, types, grading, staging and prognosis. 27 Living and radiological anatomy. 1. Discuss the normal position of different parts of the urinary system with (Anatomy) the help of living examination. 2. Understand the radiological examination, normal plain KUB and normal IVP.

28 Introductory case presentation for the 1. Understand the general outline of the reproductive system. reproductive part of the system. 2. Be familiar with the modalities of teaching throughout the course. (Multidisciplinary) 3. Acknowledge the important relation between normal and abnormal structure and function. 4. Appreciate the importance of basic sciences in clinical application.

29 Pelvic walls, perineum, and pelvic 1. Describe the structure of bony pelvis, perineum, and pelvic diaphragm. diaphragm. 2. Discuss the of the pelvis. (Anatomy) 3. Describe the radiographic images and the surface landmarks of the pelvis. 30 Urogenital diaphragm in both males 1. Describe the perineum and its boundries. and females. 2. Describe the anal triangle including anal canal, levatori anni muscles and (Anatomy) anal sphincters. 3. Describe the urogenital triangle.

31 Anatomical components of male 1. Describe the peritonial foldings on the pelvic viscera in males. reproductive system. 2. Describe male genital organs. (Anatomy) 3. Describe the relationship, blood supply, innervation, and lymph drainage of the above listed parts.

5 32 Developmental Anatomy. 1. Describe the development of gonads, genital ducts and external genitalia. “Embryology” of the reproductive 2. Describe the descent of testes and . system. (Anatomy) 33 Hormonal regulation of sex 1. Discuss the role of various and factors involved in sex determination. differentiation. (Physiology) 34 Male reproductive physiology. 1. Discuss the endocrine regulation of male reproduction. (Physiology) 2. Understand the functions of the male reproductive organs and glands 3. Discuss the process. 4. Discuss the male reproductive dysfunction. 35 Histology of the male repropductive 1. Describe the histological features of the . system. (Anatomy) 36 Androgens and their antagonists. 1. Classify and understand the nature and the mechanism of action of (Pharmacology) androgens and androgen antagonists. 2. Discuss the therapeutic uses of androgens and their abuse potential.

37 Disease of the , and 1. Identify the pathologic features of condyloma acuminatum, giant testis. condyloma, Bowen’s disease, Bowenoid papulosis, and erythroplasia of (Pathology) Queyrat. 2. Identify the etiology, pathology and complications of cryptorchidism. 3. Classify testicular tumors with emphasis on the tumor markers of seminoma, embryonal carcinoma, teratoma, yolk sac tumor and choriocarcinoma.

38 Diseases of the . 1. Identify the pathologic features of acute prostatitis, chronic prostatitis (Pathology) and chronic non-bacterial prostatitis. 2. Discuss the incidence, hormonal effects and pathology of prostatic nodular hyperplasia. 3. Recognize the incidence, hormonal effects, pathology, clinical, pathways of spread, staging, and tumor markers of prostatic carcinoma.

39 Anatomical components of the 1. Describe the peritonial foldings on the pelvic viscera in the female. female internal reproductive system. 2. Describe the structure of the female genital organs. (Anatomy) 40 Anatomical components of the 1. Describe the organs of the female urogenital triangle. female external reproductive system. 2. Describe the relationship, blood supply, innervation, and lymph drainage (Anatomy) of all the above organs. 41 Erection. 1. Discuss the mechanism and disorders of the erection process. (Physiology) 42 Histology of the female 1. Describe the histological features of the ovaries, uterine tube, and repropductive system. . (Anatomy) 43 Female reproductive 1. List the hormones of female reproduction and describe their functions. physiology-I. 2. List the functions of the female reproductive system. (Physiology) 3. Describe the pituitary axis and the changes that occur in the ovaries leading up to and following ovulation during an ovarian cycle.

44 Female reproductive 1. Describe the normal sequence of events of puberty in the female. physiology-II. 2. Discuss the structural changes that occur in the endometrium during the (Physiology) and explain how these changes are hormonally controlled. 3. Describe the physiology of the . 4. Describe the disorders of reproductive function.

45 Disease of the and vagina. 1. Recognize the histopathology and clinical significance of Lichen sclerosis, (Pathology) squamous hyperplasia, vulvar dystrophy, , extramammary Paget’s disease, condyloma acuminate, condyloma lata and vulvar intraepithelial neoplasia types (I,II,III). 2. Describe the pathologic characteristics and sites of metastases for squamous cell carcinomas of vulva and vagina.

6 46 Gonorrhoea. 1. Understand the role of Neisseria gonorrhoea as the commonest cause of (Microbiology) sexually transmitted diseases. 2. Describe the laboratory diagnosis, pathogenesis, susceptibility to antibiotics and epidemiology of N.gononrrhoea. 47 Trichomoniasis 1. Describe Trichmonas vaginalis and other ectoparasites transmitted by & Ectoparasites. sexual means, their morphology, structural features and life cycle. (Microbiology) 2. Briefly describe clinical presentations and drugs used for treatment. 48 Physiology of . 1. Describe, fertilization, transport and implantation of the developing (Physiology) ovum. 2. Describe the function of . 3. Describe the response of the mother’s body to pregnancy. 4. Describe and discuss fetal circulation. 49 Female sex steroids and 1. Describe the nature, mechanisms of actions and the adverse effects of contraceptives agents. female sex steroids and various female contraceptive agents. (Pharmacology) 2. Indicate the therapeutic applications of antiestrogenic agents. 50 Diseases of the . 1. Describe the histopathologic changes, age incidence and risk factors (Pathology) for cervical intraepithelial neoplasia and its association with human papilloma virus. 2. Discuss the age incidence, predisposing factros, pathologic characteristics and sites of metastases for squamous cell carcinoma of the cervix. 51 Infections by 1. Describe the differences in structure, morphology and replication of Chlamydia,Gardnerella, these organisms from other bacteria or viruses. andUreaplasma. 2. Describe the pathogenesis stressing the role of virulence factors and (Microbiology). their implication on the clinical picture. 3. Describe laboratory diagnosis and rationale behind treatment. 52 Parturition and lactation. 1. Discuss the factors currently thought to be involved in the initiation of (Physiology) parturition. 2. Discuss the hormonal requirements for development and establishment of lactation. 3. Describe the milk composition. 53 Diseases of the -I. 1. Understand the diagnostic approach to palpable and non-palpable breast (Pathology) lesions. 2. Describe the non-neoplastic disorders and benign tumors of the breast with emphasis on mastitis, fat necrosis, fibrocystic changes in the breast, fibroadenoma, phyllodes tumor, and intraduct papilloma. 3. List breast cancer risk factors. 54 Diseases of the breast-II. 1. Describe the major types of breast cancer including, insitu, invasive (Pathology) ductal, lobular, medullary, mucinous and tubular carcinomas. 2. List the important factors in assessing the prognosis of breast cancer. 3. Understand the role of estrogen and progesterone receptors in the management of breast cancer. 55 Drugs acting on the uterus. 1. Describe drugs (stimulants and relaxants) of the uterus and their (Pharmacology) therapeutic uses and adverse effects. 56 Disease of the uterus. 1. Distinguish between endometriosis, adenomyosis and endosalpingiosis (Pathology) by clinical, pathological features and natural history. 2. Distinguish between the different types of endometrial hyperplasia by histological appearance, clinical and natural history. 3. Understand the age incidence, and pathologic findings, of leiomyoma and leiomyosarcoma of uterus. 4. Identify age incidence, predisposing factors, hormonal influence, pathologic characteristics and sites of metastases for endometrial carcinoma. 57 Syphilis. 1. Describe the morphology of Treponema pallidum, pathogenesis and (Microbiology) laboratory diagnosis of the disease. 2. Describe the various stages of the disease and appropriate treatment as well as preventive measures.

58 Inherited diseases-I. 1. Understand the genetic bases for sex determination. (Biochemistry) 2. Understand the autosomal dominant inheritance with examples on related diseases. 2. Understand the autosomal recessive inheritance with examples on related diseases.

7 59 Inherited diseases-II. 1. Understand the sex-linked inheritance with examples on related diseases. (Biochemistry) 2. Understand the mitochondrial inheritance with examples on related diseases. 3. Understand the multifactorial inheritance with examples on related diseases.

60 Diseases of the ovaries and 1. Classify ovarian tumors with the emphasis on serous, mucinous, fallopian tubes. endometrioid carcinoma, epighelial tumors and germ cell tumors of the (Pathology) ovary. 2. Describe the age incidence, predisposing factors, pathological characteristics, sites of metastases for epithelial tumors and germ cell tumors of the ovary.

61 HIV and AIDS. 1. Describe the nature of the virus, life cycle and its role in the understanding (Microbiology) of pathogenesis and immunopathology of AIDS with emphasis on its epidemiology. 2. Describe the laboratory measures for screening, confirmation and follow up of treatment. 3. Highlight the treatment regimens and preventive measures.

62 Herpes, Cytomegalo Virus, 1. Describe the structure, morphology , replication cycle and serotypes of Human Papilloma Virus and each virus as well as epidemiology of the diseases they cause. Moluscum contagiosum. 2. Describe the pathogenesis and role of these viruses in cervical cancer. (Microbiology) 3. Describe the cell culture and serology for identification and highlight role of antiviral drugs in treatment.

63 Gestational disease. 1. Describe age incidence, predisposing factors, natural history and (Pathology) pathological characteristics for complete and partial hydatidiform mole, invasive mole and gestational choriocarcinoma.

64 . 1. Describe the morphology of Candida albicans, its pathogenesis and the (Microbiology) association between the and fungal infections. 2. Briefly describe clinical presentation and the nature of the vaginal discharge. 3. Describe laboratory methods of diagnosis as well as drugs used for treatment.

65 Infections of urinary and 1. Idetify the risk factors for urinary and reproductive system infections reproductive system. and disease. (Public Health) 66 Community awareness 1. Describe methods to promote community awareness regarding (Public Health) menses, menstrual changes, and fertility.

8 A. Practical Laboratory Sessions Lab # Lab. Title Objectives 1 Gross anatomy of the urinary 1. Define different parts of the urinary system in the abdomen and pelvis. system. 2. Localize the kidney within posterior abdominal compartment, and its relation to (Anatomy) the surrounding organs. 3. Trace the ureter from the pelvis of the kidney until the urinary bladder. 4. Define the urinary bladder and apply knowledge about its elations in the pelvic cavity both in males and females. 5. Compare the urethra in both sexes. 6. Identify all parts of the urinary system in normal conditions on plain X-rays and IVP. 7. Identify major congenital anomalies affecting this system by imaging techniques. 2 Histology. 1. Identify the microscopical appearance of the: (Anatomy) - Nephron and its parts. - . - Ureter. - Urinary bladder. - Urethra.

3 Glomerular pathology. 1. Identify the main light microscopical features of the different (Pathology) types of glomerulonephritis plus selected examples of electron microscopic (EM) and immunofluorescence (IF). (for this class use Webpath images & glass slides from your slide box).

4 Non-neoplastic diseases of the 1. Identify the congenital and cystic diseases of the kidney grossly. kidney. 2. Examine kidneys with pyelonephritis grossly and microscopically. Neoplasms of kidney and 3. Examine kidneys with , lithiasis and tuberculosis grossly; (for urothelial tumors. this class use Webpath, glass slides and gross specimens in the museum) (Pathology) 4. Examine the gross and histological slides of renal cell carcinoma and nephroblastoma (Wilms tumor). 5. Examine urinary bladder cancer grossly and histologically; (for this class use the Webpath, glass slides and gross Specimens).

5 Urinalysis and urine culture. 1. Describe methods of urine collection. (Microbiology) 2. Examine the following characteristics of urine: -Physical. -Chemical. -Microscopic. 3. Demonstrate the lab diagnosis of urinary tract infection. 4. Demonstrate the significance of antibiotic sensitivity test in urinary tract infection. 5. Identify the morphological features of Schistosoma Hematobium. 6 Pelvis I. Describe the following: (Anatomy) 1. Bony pelvis. 2. Pelvis muscles. 3. Pelvic peritoneum. 4. Urogenital triangle in males. 5. Male internal genitalia: - . - . - Ejaculatory ducts. - Prostate. - .

7 Pelvis II. Describe the following: (Anatomy) 1. Female internal genitalia: - Ovary - Uterine (Fallopian) tube. - Uterus. - Vagina. 2. The perineum. 3. Anal triangle. 4. Urogenital triangle in females. 9 5. Vessels and nerves of pelvis and perineum. 8 Male reproductive system. 1. Identify the gross and histological features of: (Pathology) - Benign prostatic hyperplasia. - Carcinoma of the prostate. - Carcinoma of the penis. - Testicular tumors. 2. Identify the gross appearance of hydrocele and torsion of testis. 3. Identify the histological features of testicular atrophy associated with infertility cases.

9 Female genital tract-I. 1. Identify and recognize the pathologic changes in: (Pathology) - Human papilloma virus infection. - Squamous cell carcinoma of the vulva, vagina and cervix. - Dysplasia and squamous intraepithelial neoplasia of the cervix. - Endometrial adenocarcinoma. - Adenomyosis and endometriosis. - Benign and tumors of the uterus.

10 Female genital 1. Identify and recognize the pathologic changes in: tract-II. - Ectopic tubal pregnancy. (Pathology) - The following ovarian tumors: serous, mucinous, granulosa cell, teratomas and Krukenberg tumor - Gestational disease: molar and choriocarcinoma.

11 Urethral Discharge. 1. Describe specimen collection methods used in sexually transmitted disease, (Microbiology) and storage of specimens. 2. Recognize in microscopic slides bacteria, fungi, and parasites causing urethral discharge. 3. 3. Culture a urethral discharge simulated specimen that has Neisseria sp. Identify it by biochemical tests.

Summary of the teaching activities in the module

Department No of Lectures No of Labs Anatomy 14 4

Physiology 13 0 Biochemistry 3 0 Pathology 17 5 Microbiology 9 2 Pharmacology 6 0 Public Health 2 0 Multidisciplinary 2 0 Total 66 11

10 Urino-Genital System (UGS, M352) (11:15-2:15)/Science Hall-2 week 1

Time Sun. Mon. Tue. Wed. Thu. 8:15 – 11:15 Lab(1) Anatomy (B) Lab(2) Histology (A) 11:15 – 12:15 Introduction to Urino- General topographic Glomerular filtration Gross anatomy and Regulation of the GF and Genital System (UGS), anatomy of the urinary (GF). histology of ureter, renal-blood flow (RBF). urinary part system. (Physiology) urinary bladder and (Physiology) (Multidisciplinary) (Anatomy) urethra. (Science Hall-2) (Anatomy) 12:15 – 1:15 12:15-1:15 Gross anatomy of the Reabsorption and Special aspects of renal Glomerulonephritis. urinary system, blood secretion. metabolism. Role of (Pathology) vessels, lymphatic (Physiology) kidney in acid base drainage and innervation. balance. (Anatomy) (Biochemistry) 1:15 – 2:15 M382 Histology of the kidney. M362 Congenital and cystic Parameter of renal active (Anatomy) diseases of the kidney. transport. (Pathology) (Physiology) 2:15 – 5:15 Lab(1) Anatomy (A) Lab(2) Histology (B)

11 Urino-Genital System (UGS, M352) (11:15-2:15)/Science Hall-2 week 2 Time Sun. Mon. Tue. Wed. Thu.

8:15 – 11:15 Lab(1) Anatomy (C) Lab(1) Anatomy (D) Lab(1) Anatomy (E) Lab(3) Pathology (C) Lab(5) Microbiology(B) Lab(2) Histology (D) Lab(2) Histology (E) Lab(2) Histology (C) Lab(4) Pathology (A) Lab(3) Pathology (E) Lab(3) Pathology (B) Lab(3) Pathology (D)

11:15 – 12:15 Renal concentration and Nephritic Syndrome. Diuretic agents-II. Embryology of the urinary Diseases of blood dilution of urine. (Pathology) (Pharmacology) system. vessels; Renal failure (Physiology) (Anatomy) (Pathology) 12:15 – 1:15 Renal clearance. Nephrotic Syndrome. Glomerular pathology in Renal tumors; Pathology of Drugs and the Kidney. (Physiology) (Pathology) systemic diseases. ureter and urinary bladder. (Pharmacology) (Pathology) (Pathology) 1:15 – 2:15 M382 Diuretic agents –I. M362 Urinary tract infection. Schistosomiasis (Pharmacology) (Microbiology) (Microbiology) 2:15 - 5:15 Lab(3) Pathology (A) Lab(5) Microbiology(E) Lab(5) Microbiology(C) Lab(4) Pathology (B)

12 Urino and reproductive system (11:15-2:15)/Science Hall-2 week 3

Time Sun Mon Tue Wed Thu

8:15 - 11:15 Lab(4) Pathology (E) Lab(4) Pathology (C) Lab(4) Pathology (D) Lab(5) Microbiology(D) Lab(5) Microbiology(A) 11:15 – 12:15 Tubulointerstitial Discussion groups Discussion groups Introduction to Urino- Urogenital diaphragm nephritis; Urinary tract Renal failure Renal failure Genital System (UGS), in both males and infection (C1, C2, C3, C4) (D1, D2, D3, D4) genital part females. (Pathology) 11:15-12:45 11:15-12:45 (Multidisciplinary) (Anatomy) 12:15 – 1:15 Living and Radiological Discussion groups (Science Hall-2) 12:15-1:15 anatomy Renal failure Anatomical (Anatomy) (A1, A2, A3, A4) components of male 1:15-2:45 reproductive system. (Anatomy) 1:15 – 2:15 M382 M362 Pelvic walls, perineum, Hormonal regulation and pelvic diaphragm. of sex determination. (Anatomy) (Physiology) 2:15 – 5:15 Discussion groups Discussion groups Renal failure Renal failure (B1, B2, B3, B4) (E1, E2, E3, E4) 2:15-3:45 2:15-3:45

13 Urino-Genital System (UGS, M352) (11:15-2:15)/Science Hall-2 week 4

Time Sun Mon Tue Wed Thu

8:15 - 11:15 Lab(6) Anatomy (A) Holiday Lab(6) Anatomy (B) Lab(6) Anatomy (C) Lab(7) Anatomy (A) Lab(8) Pathology (E)

11:15 - 12:15 Male reproductive Androgens and their Diseases of the prostate. Histology of the female physiology. antagonists. (Pathology) repropductive system. (Physiology) (Pharmacology) (Anatomy) 12:15 – 1:15 Histology of the male Diseases of the penis, Anatomical components of Erection. repropductive system. scrotum and testis. the female internal (Physiology) (Anatomy) (Pathology) reproductive system. (Anatomy) 1:15 – 2:15 M382 M362 Anatomical components of Developmental the female external Anatomy. reproductive system. “Embryology” of the (Anatomy) reproductive system. (Anatomy) 2:15 – 5:15 Lab(6) Anatomy (D) Lab(6) Anatomy (E) Lab(8) Pathology (A)

14 Urino-Genital System (UGS, M352) (11:15-2:15)/Science Hall-2 week 5

Time Sun. Mon. Tue. Wed. Thu.

8:15 - 11:15 Lab(7) Anatomy (E) Lab(7) Anatomy (D) Lab(7) Anatomy (C) Lab(7) Anatomy (B) Lab(9) Pathology (A) Lab(8) Pathology (D) Lab(8) Pathology (C) Lab(8) Pathology (B)

11:15 – 12:15 Female reproductive Diseases of the vulva and Physiology of pregnancy. Diseases of the cervix Drugs acting on the physiology-I. vagina. (Physiology) (Pathology) uterus. (Physiology) (Pathology) (Pharmacology)

12:15 – 1:15 Female reproductive Gonorrhoea. Female sex steroids and Infections by Parturition and physiology-II. contraceptives agents. Chlamydia,Gardnerella, lactation. (Microbiology) (Physiology) (Pharmacology) &Ureaplasma. (Physiology) (Microbiology). 1:15 – 2:15 M382 Trichomoniasis M362 Diseases of the uterus. Diseases of the breast-I. & Ectoparasites. (Pathology) (Pathology) (Microbiology) 2:15 – 5:15

15 Urino-Genital System (UGS, M352) (11:15-2:15)/Science Hall-2 week 6

Time Sun. Mon. Tue. Wed. Thu.

8:15 – 11:15 Lab(9) Pathology (B) Lab(9) Pathology (D) Lab(11) Microbiology (A) Lab(11) Microbiology (C) Lab(11) Microbiology (D) Lab(9) Pathology (E) Lab(10) Pathology (A) Lab(10) Pathology (C)

11:15 - 12:15 Diseases of the breast-II. Herpes,Cytomegalo HIV and AIDS. Inherited diseases-I. Genital-urinary tract (Pathology) Virus,Human Papilloma (Microbiology) (Biochemistry) infections. Virus and Moluscum (Public Health) contagiosum. (Microbiology) 12:15 – 1:15 Syphilis Candidiasis. Gestational diseases. Inherited diseases-II. Community awareness (Microbiology) (Microbiology) (Pathology) (Biochemistry) (Public Health)

1:15 – 2:15 M382 Diseases of the ovries M362 Discussion groups and fallopian tubes. Infertility (Pathology) (B1, B2, B3, B4) 1:15-2:45 2:15 - 5:15 Lab(9) Pathology (C) Lab(11) Microbiology (B)

16 Urino and reproductive system M352) (11:15-2:15)/Science Hall-2 week 7

Time Sun Mon TUE Wed Thu

8:15 – 11:15 Lab(11) Microbiology (E) Discussion groups Revision Revision Lab(10) Pathology (D) Infertility Anatomy, Physiology, Anatomy, Physiology, (C1, C2, C3, C4) Biochemistry, Biochemistry, 8:30-10:00 Pathology, Pharmacology Pathology, Pharmacology 11:15 – 12:15 Discussion groups Discussion groups and and Infertility Infertility Histology Histology (D1, D2, D3, D4) (A1, A2, A3, A4) 11:15-2:15 11:15-2:15 12:15 – 1:15 11:15-12:45 10:15-11:45 (OFFICE HOURS) (OFFICE HOURS) Discussion groups 1:15 – 2:15 M382 Infertility M362 (E1, E2, E3, E4) 12:15-1:45 2:15 – 5:15 Lab(10) Pathology (B) Lab(10) Pathology (E)

17 Case Presentation-1

Acute renal failure

A previously well 32-year-old man is brought to the emergency department having been involved in a motor vehicle accident. The circumstances of the accident are initially unclear. However, the ambulance officers who attended the accident noted that he was trapped in the vehicle for three hours before being freed. At this time he was hypotensive with a systolic of 80 mmHg, and had significant injuries to his lower limbs with probable fracture of both femora. He was initially treated with colloid and subsequently crystalloid fluid resuscitation, and his systolic blood pressure stabilized at 100 mmHg. At the time of admission to the emergency department, abdominal, thoracic, and cerebral injuries were excluded and his injuries were assessed as being confined to his lower limbs. He was tachycardic and his blood pressure was 100/60 mmHg, and his jugular venous pressure was not visible even though he was lying flat. In preparation for surgical stabilization of his lower limbs, he had a urinary inserted and 50 ml of dark urine, which tested strongly positive for blood on urinalysis, was drained, after which minimal urine output was documented.

Initial laboratory investigations revealed the following results: Hemoglobin 79 g/L 140 mmol/L Potassium 7.8 mmol/L Chloride 98 mmol/L Bicarbonate 11 mmol/L Urea 13 mmol/L Creatinine 0.19 mmol/L

Goals and Objectives: 1- Briefly summarize the case to the students. 2- List the that this patient had and explain them. 3- Define the Acute Renal Failure. 4- Discuss the causes of acute renal failure. 5- What are the factors involved in the development of this man’s acute renal failure? 6- Explain the initial laboratory findings and what additional biochemical abnormalities are likely to be present? 7- Discuss how to evaluate renal function with the emphasis on blood urea nitrogen and serum creatinine. 8- Describe in general terms the expected course and prognosis of this renal failure. 9- Discuss the complications of acute renal failure. 10- Describe the basic principles in the treatment of acute renal failure.

Case Presentation-2

Infertility

A 25 year-old married nurse had an emergency performed for fetal distress associated with a placental abruption at 38 weeks gestation. The baby was delivered safely, but the postnatal recovery was complicated by puerperal pyrexia and a foul-smelling vaginal discharge. She was next seen 3 years later in the outpatient clinic complaining of infertility. She had started trying for a second child 6 months after her caesarean section, having relied on the sheath for contraception during this time. She was still married to the same husband, had remained in good health and menstruated regularly for 4 days out of every 28 days. Nothing untoward was found on examination and a postcoital test on the 12th day of her cycle showed plentiful actively motile spermatozoa in a copious clear mucus. Serum prolactin was 258mu/L, FSH 4.6 U/L, LH 6.0 U/L and function was normal. Her Temperature chart was clearly biphasic and day 21 serum progesterone suggestive of ovulation (> 40 nmol/L). Diagnostic was therefore performed and revealed a normal uterus, right tube and ovary. The left tube, however, was bound down by adhesions to the back of the broad ligament and there was evidence of chronic and adhesions in the pouch of Douglas. The left ovary could not be seen. dye was injected through the cervix and passed easily through the right tube but not the left.

18 Objectives:

1) Briefly summarize the case to the students. 2) List the signs and symptoms that this patient had and explain them. 3) Define and classify infertility. 4) List the causes of infertility (male and female). 5) What investigations should be performed before embarking on the treatment of infertility. 6) How significant is the finding of unilateral tubal blockage in this particular case? 7) If the tubal blockage is responsible for this lady's secondary infertility, what can be done in the way of treatment? 8) Describe the basic principle in the treatment of infertility.

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